Provider Demographics
NPI:1396273405
Name:PROMEDICA CENTRAL PHYSICIANS
Entity type:Organization
Organization Name:PROMEDICA CENTRAL PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-585-1964
Mailing Address - Street 1:3430 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1547
Mailing Address - Country:US
Mailing Address - Phone:567-585-0225
Mailing Address - Fax:419-214-3564
Practice Address - Street 1:3430 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1547
Practice Address - Country:US
Practice Address - Phone:567-585-0225
Practice Address - Fax:419-214-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care